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Research ArticleOriginal Research

High-Flow Nasal Cannula and Standard Oxygen in Acute Hypoxemic Respiratory Failure Due to COVID-19

Adrián Gallardo, Adrián P Dévoli, Germán EM Bustillo Arévalo, Santiago N Saavedra, Roque S Moracci, Romina A Pratto, Gustavo A Plotnikow, José L Leone and Carolina M Travetto
Respiratory Care December 2022, 67 (12) 1534-1541; DOI: https://doi.org/10.4187/respcare.10019
Adrián Gallardo
Department of Kinesiology, Respiratory Care Unit, Sanatorio Clínica Modelo de Morón, Buenos Aires, Argentina.
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  • For correspondence: [email protected]
Adrián P Dévoli
Department of Internal Medicine, Sanatorio Clínica Modelo de Morón, Buenos Aires, Argentina.
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Germán EM Bustillo Arévalo
Department of Internal Medicine, Sanatorio Clínica Modelo de Morón, Buenos Aires, Argentina.
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Santiago N Saavedra
Department of Physical Medicine and Rehabilitation, Hospital Alemán, Buenos Aires, Argentina.
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Roque S Moracci
Department of Kinesiology, Sanatorio Anchorena, Buenos Aires, Argentina.
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Romina A Pratto
Department of Kinesiology, Sanatorio Anchorena, Buenos Aires, Argentina.
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Gustavo A Plotnikow
Department of Kinesiology, Sanatorio Anchorena, Buenos Aires, Argentina.
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José L Leone
Department of Internal Medicine, Clínica Bessone, Buenos Aires, Argentina.
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Carolina M Travetto
Department of Cardiology, Coronary Unit, Sanatorio Clínica Modelo de Morón, Buenos Aires, Argentina.
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Abstract

BACKGROUND: The evidence regarding benefits of high-flow nasal cannula (HFNC) in patients with COVID-19 is controversial. The aim of this study was to evaluate the impact of HFNC in comparison with standard oxygen therapy on the frequency of endotracheal intubation at 28 d in subjects with acute hypoxemic respiratory failure (AHRF) secondary to SARS-CoV-2 infection.

METHODS: A retrospective, age- and sex-matched–paired, cohort study was conducted in subjects with moderate-to-severe AHRF. Intervention group was treated with HFNC, and control group was treated with standard oxygen therapy. Baseline characteristics and clinical evolution were analyzed. Mantel-Haenszel test was used for categorical variables. Paired samples Wilcoxon test was used for quantitative variables. Multivariate analysis was performed using conditional multiple logistic regression.

RESULTS: Eighty-four subjects were included. The median time from admission to progression of oxygen therapy to FIO2 ≥ 0.5 or HFNC was 1 (interquartile range [IQR] 0–3) d. PaO2/FIO2 at the time of oxygen therapy progression showed a median of 150.5 (IQR 100.0–170.0) for the entire sample and was lower in HFNC group compared with control group (median 135 [IQR 96–162] vs median 158 [IQR 132–174], respectively, P = .02). Endotracheal intubation at 28 d was observed in 54.8% HFNC and 73.8% standard oxygen (unadjusted odds ratio 0.38 [95% CI 0.13–1.07], P = .069). In the multivariate analysis, presence of dyspnea at hospital admission, Sequential Organ Failure Assessment score, and PaO2/FIO2 at time of progression of oxygen therapy to FIO2 ≥ 0.5 was identified as confounding factors for the association between the intervention group and the outcome. Use of HFNC was not an independent predictor of endotracheal intubation frequency after adjusting confounders (odds ratio 0.26 [95% CI 0.04–1.51], P = .13).

CONCLUSIONS: In this study, HFNC therapy in subjects with AHRF secondary to COVID-19 was not an independent predictor of endotracheal intubation, compared with standard oxygen therapy, after adjusting for confounders.

  • COVID-19
  • HFNC
  • oxygen therapy
  • AHRF
  • comparative study
  • observational study

Footnotes

  • Correspondence: Adrián Gallardo RT, República Oriental del Uruguay 234, Morón (1708). Buenos Aires, Argentina. E-mail: adriankgallardo{at}gmail.com
  • The authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (12)
Respiratory Care
Vol. 67, Issue 12
1 Dec 2022
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High-Flow Nasal Cannula and Standard Oxygen in Acute Hypoxemic Respiratory Failure Due to COVID-19
Adrián Gallardo, Adrián P Dévoli, Germán EM Bustillo Arévalo, Santiago N Saavedra, Roque S Moracci, Romina A Pratto, Gustavo A Plotnikow, José L Leone, Carolina M Travetto
Respiratory Care Dec 2022, 67 (12) 1534-1541; DOI: 10.4187/respcare.10019

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High-Flow Nasal Cannula and Standard Oxygen in Acute Hypoxemic Respiratory Failure Due to COVID-19
Adrián Gallardo, Adrián P Dévoli, Germán EM Bustillo Arévalo, Santiago N Saavedra, Roque S Moracci, Romina A Pratto, Gustavo A Plotnikow, José L Leone, Carolina M Travetto
Respiratory Care Dec 2022, 67 (12) 1534-1541; DOI: 10.4187/respcare.10019
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Keywords

  • COVID-19
  • HFNC
  • oxygen therapy
  • AHRF
  • comparative study
  • observational study

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